Provider Demographics
NPI:1366640112
Name:COZORT, MARINA (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:COZORT
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1276 FULTON AVE
Mailing Address - Street 2:ADULT OUTPATIENT CLINIC, 8TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3402
Mailing Address - Country:US
Mailing Address - Phone:718-901-6492
Mailing Address - Fax:718-901-6490
Practice Address - Street 1:1276 FULTON AVE
Practice Address - Street 2:ADULT OUTPATIENT CLINIC, 8TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3402
Practice Address - Country:US
Practice Address - Phone:718-901-6492
Practice Address - Fax:718-901-6490
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA083566002084P0800X
NY2475202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry